Can sweeteners cause diabetes?

As a diet aid with a sweet little kick, sweeteners are very popular. But as the use of sweeteners is on the increase, so too is the prevalence of diabetes. Could the two be linked? 

Sweeteners and diabetes
Some studies have shown that the consumption of sweeteners is higher in individuals who are overweight, obese or have diabetes. However, sweeteners alone cannot cause diabetes. 

“Nutrition is complex,” says Johannesburg-based dietician, Ria Catsicas. “One food item, like artificial sweeteners, cannot cause weight gain or the development of diabetes. A person consumes on average 84 different food items a week, and it is these food patterns together with inactivity, stress and genetic predisposition that contribute to the development of obesity and consequent diabetes.”

Still, some research has found a link between sweeteners and diabetes. Lila Bruk, a dietitian based in Johannesburg agrees: “Specifically aspartame, sucralose and saccharin have been found to affect the bacteria in the gut. This can lead to an impaired glucose tolerance, and thus an increased risk of diabetes.” 

Then there are particular sweeteners that interfere with the responses that control glucose metabolism energy intake and the feeling of satiety. And, it may affect the taste receptors located throughout the digestive system that play a role in glucose absorption and hormones that trigger insulin secretion. 

However, most of these findings have been deduced from studies conducted in mice, which does not necessarily translate to humans. 

Diabetic-safe sweeteners
One of the most popular and diabetic-safe sweeteners at the moment is xylitol – a naturally occurring sugar alcohol found in the fibres of many fruits and vegetables. Xylitol looks and tastes just like sugar, but have fewer calories. Other safe sugar alcohols used as sweeteners include: 

• Erythritol.
• Sorbitol.
• Mannitol.
• Isomalt.
• Lactitol.

Another sweetener safe for diabetics that has gained great popularity over the years is stevia. Stevia is a highly concentrated, 100% natural and calorie-free sweetener extracted from the stevia plant. It is about 200 times sweeter than sugar in the same concentration. Sugar alternatives that are also sweeter than sugar include:

• Acesulfame potassium (also called acesulfame K).
• Aspartame.
• Saccharin.
• Sucralose. 
• Neotame. 
• Advantame. 

These sweeteners are safe for diabetics and have been approved by the U.S. Food and Drug Administration (FDA). They do not affect calorie intake or increase glucose levels. 

Safe and sweet
All sweeteners should be safe for diabetics, if used responsibly and within their recommended dosages, says Megan White, a registered dietician from KwaZulu-Natal. 

“The responsible use of sweeteners can be helpful in the transition of diet modification, as well as assisting and regulating glycaemic control. This will in turn decrease the risk for long-term complications of hyperglycaemia (abnormally high blood glucose levels).”

“The management of diabetes is a lifestyle encompassing healthy eating, increased activity and responsible use of medication, when prescribed. Sweeteners must be used within context of a balanced, portion and calorie controlled diet which is high in fibre and low in saturated fat. This will include unprocessed wholegrains, vegetables, fruit, lean proteins and plant fats.”  

“This may also help individuals maintain a healthy body weight, reducing the risk of developing diabetes and other lifestyle diseases, including cardiovascular disease and hypertension.”

The best bet is to get used to less sweet foods and ideally cut out sweeteners altogether, advises Bruk. “If one can start to enjoy foods and beverages without any sugar or added sweeteners, then one could be assured that any potential health risks are avoided.”